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MDMA

ECSTASY

Abuse

What is MDMA?

M

DMA is an illegal drug

that acts as both a stim- ulant and psychedelic, producing an energizing effect, as well as distortions in time and perception and enhanced enjoy- ment from tactile experiences.

Typically, MDMA (an acronym

for its chemical name 3,4-methyl- enedioxymethamphetamine) is taken orally, usually in a tablet or capsule, and its effects last approximately 3 to 6 hours. The average reported dose is one to two tablets, with each tablet typically containing between

60 and 120 milligrams of MDMA.It is not uncommon for users to

take a second dose of the drug as the effects of the first dose begin to fade.

MDMA can affect the brain by

altering the activity of chemical messengers, or neurotransmitters, which enable nerve cells in the brain to communicate with one another. Research in animals has shown that MDMA in moderate to high doses can be toxic to nerve cells that contain serotonin and can cause long-lasting damage to them. Furthermore,

MDMA raises body temperature.

On rare but largely unpredictable

occasions, this has led to severe medical consequences, including death.

Also, MDMA causes

the r elease of another neur otransmitter, norepinephrine, which is likely the cause of the increase in heart rate and blood pressure that often accompanies

MDMA use.

from the director

The so-called "club drug" MDMA

continues to be used by millions of

Americans across the country, despite

evidence of its potential harmful effects. 3 ,4-methylenedioxymethamphetamine (MDMA, or ecstasy deceptive reputation as a "safe" drug among its users. This illegal drug, which has both stimulant and psychedelic pr operties, is often taken for the feelings of well-being, stimulation, and the distortions in time and sensory percep- tions that it produces. MDMA first became popular in the "rave" and all-night party scene, but its use has now spread to a wide range of settings and demographic subgroups. According to the 2004 National Survey on Drug

Use and Health, more than 11 million

people have tried MDMA at least once.

Myths abound about both the acute

effects and long-term consequences of this drug, often called ecstasy or "X."

Indeed, one reason for the rapid rise in

the drug"s popularity is that many young people believe that MDMA is a new safe drug. But MDMA is not new to the scientific community, as many laboratories began investigating this drug in the 1980s, and the picture emerging from their efforts is of a drug that is far from benign. For example,

MDMA can cause a dangerous

increase in body temperature that can lead to kidney failure. MDMA can also increase heart rate, blood pressure, and heart wall stress. Animal studies show that MDMA can damage specific neur ons in the brain. In humans, the research is not conclusive at this time; however, a number of studies show that long-ter m, heavy MDMA users suffer cognitive deficits, including problems with memory.

NIDA-supported research is develop-

ing a clearer picture of the potential dangers of MDMA, and this

Research

Report

summarizes the latest findings.

We hope that this compilation of

scientific information will inform readers and help the public recognize the risks of MDMA use.

Nora D.Volkow,M.D.

Director

National Institute on Drug Abuse

U.S. Department of Health and Human Services

National Institutes of Health

Research Report

NATIONAL INSTITUTE ON DRUG ABUSE

SERIES

Although MDMA is known

universally among users as ecstasy, researchers have deter- mined that many ecstasy tablets contain not only MDMA but also a number of other drugs or drug combinations that can be harm- ful as well. Adulterants found in

MDMA tablets purchased on the

street include methamphetamine, caffeine, the over-the-counter cough suppressant dextromethor- phan, the diet drug ephedrine, and cocaine. Also, as with many other drugs of abuse, MDMA is rarely used alone. It is not uncommon for users to mix

MDMA with other substances,

such as alcohol and marijuana.

A brief history

of MDMA M

DMA was developed

in Germany in the early 1900s as a parent compound to be used to synthesize other pharmaceuticals.

During the 1970s, in the United

States, some psychiatrists began

using MDMA as a psychothera- peutic tool, despite the fact that the drug had never undergone formal clinical trials nor received approval from the U.S. Food and

Drug Administration (FDA

use in humans. In fact, it was only in late 2000 that the FDA approved the first small clinical trial for MDMA that will deter- mine if the drug can be used safely with 2 sessions of ongoingpsychotherapy under carefully monitored conditions to treat post-traumatic stress disorder.

Nevertheless, the drug gained a

small following among psychia- trists in the late 1970s and early

1980s, with some even calling it

"penicillin for the soul" because it was perceived to enhance communication in patient sessions and reportedly allowed users to achieve insights about their problems. It was also during this time that MDMA first started becoming available on the street. In 1985, the U.S. Drug

Enforcement Administration (DEA

banned the drug, placing it on its list of Schedule I drugs, corre- sponding to those substances with no proven therapeutic value.

What is the

scope of MDMA abuse in the U.S.? I t is difficult to determine the exact scope of this problem because MDMA is often used in combination with other substances, and does not appear in some traditional data sources, such as treatment admission rates.

More than 11 million persons

aged 12 or older reported using ecstasy at least once in their lifetimes, according to the 2004

National Survey on Drug Use

and Health. The number of current (use in past month users in 2004 was estimated to be 450,000.

The Drug Abuse Warning

Network, maintained by the

Substance Abuse and Mental

2NIDA RESEARCH REPORT SERIES

Serotonin Present in Cerebral Cortex Neurons

Long-term effects in monkeys. The left panel is brain tissue from a normal monkey. The middle and right panels illustrate the loss of serotonin-containing nerve endings following MDMA exposure.

CONTROL2 WEEKS AFTER ECSTASY7 YEARS AFTER ECSTASY

Health Services Administration,

reported that mentions of MDMA in drug abuse-related cases in hospital emergency departments were 2,221 for the third and fourth quarters of 2003. The majority of patients who came to emergency departments mentioning MDMA as a factor in their admissions during that time were aged 18-20.

There is, however, some

encouraging news from NIDA"s

Monitoring the Future (MTF

survey, an annual survey used to track drug abuse trends among adolescents in middle and high schools across the country.

Between 2001 and 2005, annual

ecstasy use decreased by 52 per- cent in 8th-graders, 58 percent in 10th-graders, and 67 percent in 12th-graders. Rates of lifetimeMDMA use decreased significantly from 2004 to 2005 among 12th- graders.

In 2005, 8th-graders reported a

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